Home Health Care
Dear Editor: I have been following the commentaries on SEARHC’s upcoming closure of Sitka’s Home Health Care office. I was concerned when I read the Sentinel’s August 2 interview with Dr. Bruhl, SEARHC senior vice president and chief medical officer, particularly when he concluded his statements with ‘‘we share their (patients’) concerns and want and hope to find solutions to the need for skilled and licensed care in that situation (ability to remain at home at end of life).’’ I would expect that, prior to closing this department, there would be a comprehensive plan for meeting the home health care needs of our community.
Dr. Bruhl cited the ‘‘tremendous regulatory burden’’ of maintaining a Home Health Care department as a prominent factor in this decision. Regulations are established to standardize the health care delivery system. These regulations allow patients to have some expectations about the services and the quality of care that they will receive, whether they are in the hospital, long-term care or home care settings.
Medicare and other health insurance companies look to these regulations when determining reimbursement policies. For example, for Medicare reimbursement for home health services, a patient needs to have a face-to-face assessment by a physician, nurse practitioner or other health care provider who certifies the need for home health care. The provider then must place an order for the care and a Medicare-certified home health agency must provide it (for Medicare to pay for those services.) If an individual is covered by Medicare, who will pay for home care services rendered by SEARHC when these services are no longer regulated?
Dr. Bruhl stated, ‘‘We’ll be able to provide physician home visits, we’ll be able to support people at the end of life in the hospital, or even in the long- term care facility if we need to.’’ Home health care is more cost-effective than inpatient or long-term care. And there are standards that regulate inpatient and long-term care hospitalizations. These regulations may prevent insurance reimbursement for hospitalized individuals who would otherwise qualify for and benefit from home health care.
In her letter to the editor on Aug. 11, Dr. Marilyn Coruzzi described her years of experience with home health nurses and the comprehensive care offered through this service, as noted, home health care is generally defined as medically necessary part-time or intermittent SKILLED NURSING CARE, physical therapy, speech-language pathology services or occupational therapy services; and may include medical social services, part-time or intermittent home health aide services, durable medical equipment and supplies for use at home.
Skilled nursing care is key to the effective coordination and provision of home care services. In this Home Health department, there is a foundation of nursing expertise, experience, and skill that deserves to be acknowledged and valued. I hope this consideration would go beyond (to quote Dr. Bruhl) ‘‘SEARHC is working to find positions elsewhere in SEARHC for the employees in the department.’’ Will this nursing expertise, experience and skill be lost? The major team players (including home health nurses) should be at the table as the home health care program is revised and implemented, to best serve this community. The community needs to know that we will be supported as we all attempt to gracefully ‘‘age in place.’’
I appreciate the Daily Sitka Sentinel staff for helping us to remain informed on these important community issues, including the letters to the editor (thank you, Cindy, Carolyn, Kim and Marilyn), as well as STA’s commitment to home health care.
Elizabeth (Bitsy) Mosher, RN, MSN/FNP (retired), Sitka
